Provider First Line Business Practice Location Address:
562 WYOMING AVE
Provider Second Line Business Practice Location Address:
CHOICES PROGRAM OF WYOMING VALLEY
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-552-3700
Provider Business Practice Location Address Fax Number:
570-552-3705
Provider Enumeration Date:
11/02/2010